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' r TOS <br /> Technologies Soil Recylin "g <br /> Nn-Hazrdous �- rt <br /> t <br /> Soils <br /> �^ >�of Shipment: Responsible for Payment: Transporter Truck 0: :' Facility N: Given by TPS: Lead N <br /> Constaltent A07 05325 <br /> Geucrator's Name and Billing Addressr enera or's Phone#: Generator's US EPA!D No. <br /> THRIFTY OIL 'COMPANY <br /> r Person to Con tact: <br /> 10000 LAKEWOOD BLVD. <br /> FAX#: k Customer Account Number with TPS: <br /> CA q@240 HCZA <br /> Consultant's Name and Billing Address: Consultant's Phone#: 's^ <br /> . <br /> MANESS ENVSERVICES, INC. <br /> c Person to ontac <br /> 1101 E. SPRING STREETak` <br /> RTfFAX#: !� Customer Account Number%rich TPS: <br /> LUNG BEACH CA 90809 USA �,, r l <br /> Generation Site(Transport from): (earn&address) Site Phone#: BTEX r_r. <br /> Levels <br /> THRIFTY OIL #171 Person to Contact:K TPH p <br /> ` t L50ti,-_WAYS _ <br /> • - �. 250 T1.,.:.5�t I ,Levels <br /> F AVG. <br /> C Levels <br /> { V Designated Facility(Transport to): (tarrae&address) . Facility Phone#: 1' Facility Permit Numbers ���.,�'- <br /> �' <br /> TPSTECHNOLOGIES Person to Contact:; <br /> ' 12324 HIBISCUS AVE. I lA <br /> o FAX#: <br /> Gni Transporter Name and Mailing Address: Transporter's Phone#: Transporter's US EPA ID No.: <br /> w IMANESS- ENV, -'SERVICES, INC. <br /> = Person to Contact Transporter's DOT No.: ". <br /> 1101 E. SPRING STREET I� � <br /> #• ; li Customer Account Number with TPS: i <br /> LONG BEACH, "CA 90809 USA ( 310) 492-6495 7MANESS <br /> Description of Soil Moisture Content. Contaminated by: Approx.(qty: Description of Delivery Gross Weight Tare Weight Net Weight <br /> . sand ❑ Organir❑ 0-10% ❑ . Gas ❑ <br /> 10-20% Q 'Diesel ❑ tF <br /> y_ Clay ❑ Ether O �. . . 20%-over Q lather ❑ <br /> Sand a organic❑ 0.-10% Q Gas ❑ <br /> 30- 20% ❑ Diesel ❑ <br /> Clay ❑ (they ❑ 20%-over❑ Other ❑ <br /> •;ix: List any exception to items listed above. <br /> Generator's andjor-consultant's certification:"IIWe certify that the soil referenced:herein is.taL-n-e;:firely frvrn those soils-described.in the Scil Data <br /> Sheet completed and certified by me/us'for the Generation Site shown above and nothing has been added or done to such soil that would alter it in� <br /> any way. <br /> Print aq Type Name: Generator ❑ Consultant ❑ signature and da ;i if Month Day Year ;+ <br /> x�z <br /> RiCHM OKUDA AGENT FOR THRIFTY 01g !6 f3O 95 $ <br /> f y Transporter's certification: I/We acknowledge receipt of the soildescribed above and c i that s ch Ing ed in exactly the same r <br /> ocondition as when received. I/We further certify that this soil is being directly transported from the Generation Site to the Designated Facility ! <br /> y without off-loading,adding to,subtracting from or in any way delaying delivery to such site. ' <br /> co Print or Type Name. sipand date: Month Day Year <br /> X }' GREG MARISRAL i _ } <br /> Disaepandes: <br /> ttj <br /> i SII <br /> L�+ S Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: <br /> N, Print or Type Name: Signatumand date: <br /> TRANSPORTER'S COPY }} <br />